An athlete's sudden death was in the news this past
weekend. While the heat was the prime suspect, a more
hidden culprit was actually to blame.
"An autopsy on the body of a Michigan police officer who
died running in Sunday's Chicago Marathon reveals that he
had a heart condition. The Cook County medical examiner
says Chad Schieber suffered from mitral valve prolapse _ a
condition that occurs when one of the heart's valves
doesn't work properly. ... The medical examiner's office
says Schieber's collapse had nothing to do with yesterday's
brutally hot weather."http://www.msnbc.msn.com/id/21195031/

While such conditions are rare, they are not entirely
unknown.

"Doctors have known for years that when a seemingly healthy
person dies suddenly, as did former Missouri running back
Damien Nash on Feb. 24 [2007], the most common cause is an
undetected heart condition. Among those conditions is HCM,
which Dr. Keith Mankowitz, director of the Hypertrophic
Cardiomyopathy Clinic at Barnes-Jewish Hospital, says is
responsible for 36 percent of sudden deaths among athletes
younger than 35. ... HCM, which is estimated to be present
in 1 in 500 people, according to the New England Journal of
Medicine, has been tied to the deaths of many high-profile
athletes, including basketball players Hank Gathers and
Reggie Lewis, figure skater Sergei Grinkov and several
international soccer stars."http://www.barnesjewish.org/cardio/default.asp?NavID=4006

While high-profile events (like the record-breaking
temperatures at the Chicago Marathon) or high profile
athletes (professional athletes that those who follow the
sport would know) draw national news coverage, local media
coverage often explodes when the death of a high school or
college athlete shocks a community.

"When an otherwise superbly-conditioned teenager dies
suddenly, a condition called sudden cardiac death is often
to blame, say experts. Spotting these cases in pre-athletic
medical screenings can be a challenge when there are no
prior problems to report." University of Texas Health Science Center

While some may have no symptoms, others may have symptoms
that they did not feel were serious enough to report.

"'Typically the athletes have had symptoms as a warning,
but they may have ignored it or assumed that they had just
overdone it, over-exerted themselves or become too
dehydrated.' ... Reports of sudden death are scary, but
parents and students should keep in mind that, despite the
media blitz these cases receive, this is an unusual event.
It seems that with each tragic loss, the anxiety and fear
of children dying of this is elevated exponentially above
the actually risk. 'Cardiac conditions with a
predisposition to sudden death during or following exercise
occur in about 5 of 100,000 participants and sudden death
occurs in 0.5 of 100,000 people,' Rao says."University of Texas Health Science Center

The cases are rare, but when they do strike a community,
they bring with them a fear of what might happen.

"Testing athletes' hearts dramatically lowered the rate of
sports-related sudden cardiac deaths in Italy, a study
suggests, but experts said it was not clear such an effort
would have as big a payoff in the United States. There are
roughly two dozen sports-related deaths of high school and
college students from sudden cardiac arrest in the United
States each year. Only a handful of schools require
electrocardiogram, or EKG, screening. Since 1982, Italy has
required all athletes to get EKGs for hidden heart problems
before playing competitive sports, and about 2 percent are
disqualified because of heart problems. Researchers from
the University of Padua Medical School analyzed trends in
sudden deaths from heart problems before and after the
program began. They looked at both athletes and
non-athletes, ages 12 to 35, in the Veneto region of
northeastern Italy between 1979 and 2004. They found that,
among athletes, the rate of sudden deaths fell by 89
percent over the 25 year-period. The rate among
non-athletes did not change."University of Connecticut Health Center

With 2% of athletes being disqualified in Italy, and 0.005%
of athletes with "a predisposition to sudden death during
or following exercise," some see screening all prospective
athletes as an expensive undertaking that has the potential
to provide false positives and create concerns that can
lead to the restriction of activity in a generation that is
already fighting obesity at increasing rates. Others see it
as a way to catch those with the highest risks and offer
them some hope.

"If we're able to identify someone as being at high risk of
sudden death, there are preventive options. For example, we
can prescribe medications such as beta blockers that affect
a person's heart rate. Another option for some, such as
those with hypertrophic cardiomyopathy, is an implantable
cardioverter-defibrillator (ICD). This is a pager-sized
device implanted in your chest like a pacemaker. An ICD
continuously monitors your heartbeat. If a life-threatening
arrhythmia occurs, the ICD delivers a precisely calibrated
electrical shock(s) to restore a normal heart rhythm."http://www.mayoclinic.com/health/sudden-death/HB00092

Questions of the Week:
Who should be screened for potential heart conditions? Who
should determine if the results of the screening would
disqualify a prospective athlete from training and/ or
competing, and what should the criteria be? What symptoms
should athletes (of all ages) be sure to share with their
doctors?

Please email me with any ideas or suggestions.
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